Provider Demographics
NPI:1235469016
Name:WELLNESS CENTER FOR SPORT & SPINE, INC.
Entity Type:Organization
Organization Name:WELLNESS CENTER FOR SPORT & SPINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GIL
Authorized Official - Middle Name:Z
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:970-493-3100
Mailing Address - Street 1:181 W. BOARDWALK DR.
Mailing Address - Street 2:UNIT 204
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-3033
Mailing Address - Country:US
Mailing Address - Phone:970-493-3100
Mailing Address - Fax:970-237-4802
Practice Address - Street 1:181 W. BOARDWALK DR.
Practice Address - Street 2:UNIT 204
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3033
Practice Address - Country:US
Practice Address - Phone:970-493-3100
Practice Address - Fax:970-237-4802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-30
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR5682111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty